Metastasis-directed therapy: new standard or too early to change paradigm?

Metastasis-directed therapy (MDT) is an emerging treatment strategy for patients with oligometastatic prostate cancer (PCa), particularly for oligorecurrent disease. This review aims to summarize findings from several prospective trials in the setting of oligorecurrent PCa. We found that MDT is feasible, has high tolerability, and is effective in terms of local control of treated lesions and of deferring disease progression in well-selected patients. Selecting patients for MDT requires thoughtful consideration of factors such as the castration status, the number of detected metastases, and the imaging modality used for metastasis detection. Notably, the studies included in this review varied in terms of these factors, complicating the comparability of their results. Despite the existence of several prospective clinical trials in the field, there is an absence of high-level evidence attributable to the lack of phase 3 clinical trials. As a result, current guidelines recommend the administration of MDT exclusively within the context of clinical trials. Despite this, retrospective series indicate that MDT is already frequently utilized outside of clinical trials.